Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2023 Mar;165(3):1093-1098. doi: 10.1016/j.jtcvs.2021.07.047. Epub 2021 Aug 10.
The study objective was to investigate the impact of multiple arterial grafting on long-term all-cause mortality in women undergoing isolated coronary artery bypass grafting.
A comprehensive search was performed to identify observational studies reporting outcomes after coronary artery bypass grafting reported by sex and stratified into multiple arterial grafting versus single arterial grafting strategies. Articles were considered for inclusion if they were written in English and were propensity-matched observational studies. Included studies were then pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was long-term all-cause mortality. Secondary outcomes were operative mortality and spontaneous myocardial infarction. Meta-regression was used to explore the effects of preoperative and intraoperative variables on the primary outcome.
A total of 6 studies with 32,793 women (25,714 single arterial grafting and 7079 multiple arterial grafting) were included. Women who received multiple arterial grafting had lower long-term mortality (incidence rate ratio, 0.86; 95% confidence interval, 0.76-0.96; P = .007) and spontaneous myocardial infarction (incidence rate ratio, 0.80; 95% confidence interval, 0.68-0.93; P = .003) compared with women who received single arterial grafting, but the difference in mortality disappeared when including only the 3 largest studies. There was no difference between groups in operative mortality (odds ratio, 0.99; 95% confidence interval, 0.84-1.17; P = .91). Meta-regression did not identify any associations with the incidence rate ratio for long-term mortality.
The use of multiple arterial grafting in women undergoing coronary artery bypass grafting is associated with lower long-term mortality, although the difference is mostly driven by small series. Further studies, including randomized trials, are needed to evaluate the efficacy of multiple arterial grafting in women undergoing coronary artery bypass grafting.
本研究旨在探讨女性患者行冠状动脉旁路移植术（CABG）时，多支动脉搭桥对全因死亡率的长期影响。
通过全面检索，我们确定了符合以下标准的观察性研究：按性别分层，报告 CABG 术后结局，包括多支动脉搭桥和单支动脉搭桥策略。如果文章为英文且为倾向评分匹配的观察性研究，则被认为符合纳入标准。纳入的研究采用通用倒数方差法进行荟萃分析。主要结局为长期全因死亡率。次要结局为手术死亡率和自发性心肌梗死。采用元回归分析来探讨术前和术中变量对主要结局的影响。
共纳入 6 项研究，涉及 32793 名女性（25714 名接受单支动脉搭桥，7079 名接受多支动脉搭桥）。与接受单支动脉搭桥的女性相比，接受多支动脉搭桥的女性长期死亡率（发生率比，0.86；95%置信区间，0.76-0.96；P =.007）和自发性心肌梗死（发生率比，0.80；95%置信区间，0.68-0.93；P =.003）更低，但纳入 3 项最大规模的研究后，死亡率的差异消失。两组手术死亡率无差异（比值比，0.99；95%置信区间，0.84-1.17；P =.91）。元回归分析未发现与长期死亡率发生率比相关的任何因素。
女性行 CABG 时采用多支动脉搭桥与较低的长期死亡率相关，尽管这种差异主要是由小系列研究驱动的。需要进一步的研究，包括随机试验，来评估多支动脉搭桥在女性 CABG 中的疗效。
